Is it wise to sample a growth in the body to ascertain if it is cancerous? The standard of care in medicine believes it is. I am not so sure.
An article in Cancer Cytopathology (doi:10.1002/oncy.2120; Accepted June 18, 2012) reported that a commonly used biopsy method can result in complications. Fine needle aspiration (FNA) is a common medical procedure used to obtain tissue for pathological examination. It is used in thyroid biopsies. FNA is done by inserting a small needle into the tissue and aspirating a sample. The aspirate is then placed on a slide for pathological examination. Researchers studied 96 subjects who underwent a thyroidectomy—they had their whole thyroid gland removed. These same subjects had previously been subjected to a FNA of their thyroid gland.
The scientists reported that 68 of the 96 (71%) thyroidectomy specimens examined had needle tracks. That means that the previous biopsies–the FNA’s—were still visible after the whole thyroid gland was removed. The longest time between the FNA and the thyroidectomy surgery was reported to be >81 days. In this population, 74% were found to have needle tracks.
What is wrong with a needle track? Cancer becomes a bigger problem when it spreads. When you introduce a needle into a cancerous mass, upon withdrawal of the needle, cancer cells can be released into the needle track. Now, for thyroid biopsies, FNA might be an appropriate diagnostic procedure since thyroid cancer is (usually) a slow growing tumor. However, for other tissue such as the breast or the prostate, the answer is not so clear.
In fact, I think it is questionable whether we should be doing so many biopsies of the prostate and the breast. Breast and prostate biopsies are done with larger needles as compared to thyroid FNA. In fact, when the prostate is biopsied, it is done with multiple needles. A larger needle will, of course, leave a larger needle tract. Research has not been totally clear whether the risk of a biopsy—the possibility of spreading the cancer in a needle tract—outweighs the benefit. The benefit of FNA is that it is an easy procedure to do and recovery is faster for a patient as compared to a bigger surgery where the lesion is removed in total.
So what can you do? I say, if the lesion is small enough and looks suspicious enough to biopsy, forgo the biopsy and opt for a total excision (i.e., removal) of the mass. I see many women who develop suspicious masses on a mammographic examination. For a small mass, rather than a biopsy, I believe it is better to excise the mass. After excision, it can be pathologically examined. Are there complications to opting for a complete excision rather than a biopsy? Yes. The main complication would be that it is a more difficult procedure and the patient’s recovery will be prolonged since the surgery is more advanced. However, I think the risk of spreading a cancerous mass will be much lower. And, avoiding cancerous spread should be the primary focus of any diagnostic test.
Before blindly allowing a radiologist or a surgeon to biopsy a mass, it may be wise to step back and get a second opinion.
Too true! I had a needle biopsy due to a 1 cm lung lesion (left upper lobe). At the time, I had no knowledge of the danger of the procedure in spreading cancer cells nor the knowledge that the subsequent diagnosis of Small Cell Lung Cancer (SCLC) was a virtual death sentence.
My first response was to immediately begin Chemo and radiation treatments. Having attained complete (but temporary) remission, Prophylactic Cranial Radiation was recommended to avoid possible brain tumors. Being pro-active, I agreed.
All OK but I felt physically destroyed and spent most of my time in bed, mind still buzzing from the chemo. All the time, I was studying alternative treatments on my own. Then, 14 months later, a recurrent tumor in the right lung. I knew that was the end game and refused further treatment knowing (but not informed) that would only be palliative.
The following Monday, I admitted myself to a cancer clinic in Mexico which does immune therapy and various natural treatments. I left the clinic 30 days later in full remission and have been so for the last ten years. I have no doubt that they saved my life.
In those ten years, mostly due to insurance changes (either theirs or mine) I have seen about 5 oncologists. To the one, they are amazed and shocked when they meet a patient that actually survived SCLC. One told me that was impossible. I asked why. He replied “Because you would be dead”. He wasn’t joking.
The sad ant tragic fact is that none of these 5 oncologists ever asked how the clinic did it. Not only did they not know, they didn’t want to know. Now if my auto mechanic was unable to fix my car’s engine and a mechanic in Mexico was able to do so, I believe my mechanic would love to know the answer to the puzzle. Professional interest don’t you think? But not my oncologists. That is really sick. They dare not anger the drug companies, their attorneys, or the FDA that supports the whole thing.
I have documented the entire experience for the benefit of cancer patients everywhere on my web site http://www.SurvivingSmallCell.com.
Look after yourselves, nobody else is going to.
I had nodules on both sides of my thyroid. I went for a biopsy and the nodules were found to be benign. The biopsy was VERY painful. I learned later that I could have gone for a thermography instead. The procedure would have cost $150.00 and been painless. I ended up owing $200.00 after the insurance paid their portion so I would have saved myself a lot of pain had I know about thermography before that. I am learning as I go. I have since gone to an alternative doctor and found out how to take care of my thyroid. This alternative doctor gave me one of your cds about thyroid health and also one on iodine. I’m hoping that the iodine will also shrink the nodules so that they don’t become cancerous at a later date. Your cds were so informative. I now know what I have to do to take care of my thyroid. Thank you Dr. Brownstein for caring about us and letting us know the alternatives to prescription medications.
Dr. Brownstein, to support your point, a study was done in 2004 comparing the outcome of fine needle biopsies, large needle (sterotactic) biopsies and excisional (surgical) biopsies in breast cancer patients. The fine needle biopsies displaced cells to the lymph nodes 50% more than the surgical biopsies.
Patients need to remember they have a choice when it comes to biopsies. If cancer cells are displaced or spread to the nodes during a needle biopsy a patient’s cancer status may be staged higher and more aggressive treatment will be recommended. Unfortunately, even thought the study was conducted in 2004, no change was recommended in biopsy procedures. http://archsurg.jamanetwork.com/article.aspx?articleid=396893
Folks,
Lynne Farrow runs an important website that provides a lot of information about breast cancer. Please go to: http://breastcancerchoices.org/ for more info.
Dr.B